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Research Article| Volume 19, ISSUE 4, P713-742, December 1999

Monitoring Anatomic Pathology Practice Through Quality Assurance Measures

  • Richard J. Zarbo
    Correspondence
    Address reprint requests to: Richard J. Zarbo, MD, DMD Department of Pathology Henry Ford Hospital 2799 West Grand Boulevard Detroit, MI 48202
    Affiliations
    From the Department of Pathology, Henry Ford Hospital, Henry Ford Health Sciences Center/Case Western Reserve University, and the Quality Practices Committee, College of American Pathologists, Detroit, Michigan
    Search for articles by this author
DOI:https://doi.org/10.1016/S0272-2712(18)30086-6
Monitoring Anatomic Pathology Practice Through Quality Assurance Measures
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Next ArticleDiagnostic Errors in Surgical Pathology
      This paper is only available as a PDF. To read, Please Download here.
      This article describes the art and science of continuous performance measurement and applications for quality improvement in anatomic pathology. Numerous novel benchmarks derived from multi-institutional data acquired from the College of American Pathologists Q-Probes quality improvement program are illustrated as they relate to specific disciplines in anatomic pathology and aspects of the total testing cycle. Comparative data quantifying performance deficiencies and opportunities for practice improvement are also identified.
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      References

        • Abt A.B.
        • Abt L.G.
        • Olt G.J.
        The effect of interinstitution anatomic pathology consultation on patient care.
        Arch Pathol Lab Med. 1995; 119: 514-517
        • Association of Directors of Anatomic and Surgical Pathology
        Consultations in surgical pathology.
        Am J Surg Pathol. 1993; 17: 743-745
        • Association of Directors of Anatomic and Surgical Pathology
        Recommendations on quality control and quality assurance in anatomic pathology.
        Am J Surg Pathol. 1991; 15: 1007-1009
        • Association of Directors of Anatomic and Surgical Pathology
        Standardization of the surgical pathology report.
        Am J Surg Pathol. 1992; 16: 84-86
        • Bachner P.
        • Howanitz P.J.
        • Lent R.W.
        Quality improvement practices in clinical and anatomic pathology services. A College of American Pathologists Q-Probes Study of the program characteristics and performance in 580 institutions.
        Am J Clin Pathol. 1994; 102: 567-571
        • Baker P.B.
        • Nakhleh R.E.
        Q-Probes 95-09: Autopsy Result Utilization. Data Analysis and Critique. College of American Pathologists, Northfield, IL1995
        • Baker P.B.
        • Saladino A.J.
        Q-Probes 93-06: Autopsy Contributions in Quality Assurance. Data Analysis and Critique. College of American Pathologists, Northfield, IL1994
        • Baker P.B.
        • Zarbo R.J.
        Q-Probes 90-09A: Autopsy Report Adequacy. Data Analysis and Critique. College of American Pathologists, Northfield, IL1990
        • Baker P.
        • Zarbo R.J.
        Q-Probes 92-03: Autopsy Timeliness and Permit Adequacy. Data Analysis and Critique. College of American Pathologists, Northfield, IL1993
        • Baker P.B.
        • Zarbo R.J.
        • Howanitz P.J.
        Quality assurance of autopsy face sheet reporting, final autopsy report turnaround time, and autopsy rates. A College of American Pathologists Q-Probes study of 10,003 autopsies from 418 institutions.
        Arch Pathol Lab Med. 1996; 120: 1003-1008
        • Commission on Laboratory Accreditation
        1997 Inspection Checklist: Autopsy Pathology. College of American Pathologists, Northfield, IL1998
        • CPT 95
        Physicians’ Current Procedural Terminology. American Medical Association, Chicago1995
        • Cramer S.F.
        • Roth L.M.
        • Ulbright T.M.
        • et al.
        The mystique of the mistake: With proposed standards for validating proficiency tests in anatomic pathology.
        Am J Clin Pathol. 1991; 96: 774-777
        • Fenoglio-Preiser C.M.
        • Zarbo R.J.
        Q-Probes 90-14A: Breast Carcinoma Surgical Pathology Report Adequacy. Data Analysis and Critique. College of American Pathologists, Northfield, IL1990
      15. Fleming I.D. AJCC Cancer staging manual. American Joint Committee on Cancer. ed 5. Lippincott-Raven, Philadelphia1997
        • Gephardt G.N.
        • Baker P.B.
        Interinstitutional comparison of bladder carcinoma surgical pathology report adequacy. A College of American Pathologists Q-Probes study of 7234 bladder biopsies and curettings in 268 institutions.
        Arch Pathol Lab Med. 1995; 119: 681-685
        • Gephardt G.N.
        • Baker P.B.
        Q-Probes 91-06A: Lung Carcinoma Surgical Pathology Report Adequacy: Data Analysis and Critique. College of American Pathologists, Northfield, IL1992
        • Gephardt G.N.
        • Baker P.
        Q-Probes 92-06: Bladder Carcinoma Surgical Pathology Report Adequacy. Data Analysis and Critique. College of American Pathologists, Northfield, IL1993
        • Gephardt G.N.
        • Zarbo R.J.
        Extraneous tissue in surgical pathology. A College of American Pathologists Q-Probes study of 275 laboratories.
        Arch Pathol Lab Med. 1996; 120: 1009-1014
        • Gephardt G.N.
        • Zarbo R.J.
        Interinstitutional comparison of frozen section consultations. A College of American Pathologist’s Q-Probes study of 90,538 cases in 461 institutions.
        Arch Pathol Lab Med. 1997; 120: 804-809
        • Gephardt G.
        • Zarbo R.J.
        Q-Probes 90-20A: Surgical Pathology Frozen Section Consultation: Data Analysis and Critique. College of American Pathologists, Northfield, IL1991
        • Gephardt G.N.
        • Zarbo R.J.
        Q-Probes 94-03: Extraneous Tissue in Surgical Pathology Slides: Data Analysis and Critique. College of American Pathologists, Northfield, IL1995
        • Goldman L.
        Diagnostic advances vs the autopsy.
        Arch Pathol Lab Med. 1984; 108: 501-505
        • Goldman L.
        • Sayson R.
        • Robbins S.
        • et al.
        The value of the autopsy in three medical eras.
        N Engl J Med. 1983; 308: 1000-1005
        • Heard N.V.
        • Zarbo R.J.
        Q-Probes 91-11 A: Cervicovaginal Cytology Specimen Adequacy: Data Analysis and Critique. College of American Pathologists, Northfield, IL1992
        • Henson D.E.
        Editorial: Opportunities unexplored.
        Arch Pathol Lab Med. 1990; 114: 565
        • Henson D.E.
        • Frelick R.W.
        • Ford L.G.
        • et al.
        Results of a national survey of characteristics of hospital tumor conferences.
        Surg Gynecol Obstet. 1990; 170: 1-6
        • Hoffman G.G.
        Q-Probes 89-01A: Surgical Pathology Frozen Section Consultation: Data Analysis and Critique. College of American Pathologists, Northfield, IL1989

      29. Joint Commission on Accreditation of Healthcare Organizations. Accreditation Manual for Hospitals. Oakbrook Terrace, IL, Joint Commission of Healthcare Organizations, 1997

        • Jones B.A.
        Rescreening in gynecologic cytology: Rescreening of 3762 previous cases for current high grade squamous intraepithelial lesions and carcinoma. A College of American Pathologists Q-Probes study of 312 institutions.
        Arch Pathol Lab Med. 1995; 119: 1097-1103
        • Jones B.A.
        • Heard N.V.
        Q-Probes 93-03: Pap Smear Rescreening. Data Analysis and Critique. College of American Pathologists, Northfield, IL1993
        • Jones B.A.
        • Novis D.A.
        Cervical biopsy-cytology correlation: A College of American Pathologists Q-Probes study of 22,439 correlations in 348 laboratories.
        Arch Pathol Lab Med. 1996; 120: 523-531
        • Jones B.A.
        • Novis D.A.
        Q-Probes 94-09: Cervical Biopsy-Cytology Correlation. Data Analysis and Critique. College of American Pathologists, Northfield, IL1995
        • Jones B.A.
        • Novis D.
        Q-Probes 97-02: Gynecologic Cytology Turnaround Time. CAP Q-Probes Quality Assurance Program. College of American Pathologists, Northfield, IL1997
        • Landefeld C.S.
        • Chren M-M.
        • Myers A.
        • et al.
        Diagnostic yield of the autopsy in a university hospital and a community hospital.
        N Engl J Med. 1988; 318: 1249-1254
        • Lind A.C.
        • Bewtra C.
        • Healy J.C.
        • et al.
        Prospective peer review in surgical pathology.
        Am J Clin Pathol. 1995; 104: 560-566
        • Markei S.F.
        • Hirsch S.D.
        Synoptic surgical pathology reporting.
        Hum Pathol. 1991; 22: 807-810
        • McBroom H.M.
        • Ramsay A.D.
        The clinicopathologic meeting: A means of auditing diagnostic performance.
        Am J Surg Pathol. 1993; 17: 75-80
        • Nakhleh R.E.
        • Baker P.B.
        • Zarbo R.J.
        Autopsy result utilization: A College of American Pathologist Q-Probes study of 256 laboratories.
        Arch Pathol Lab Med. 1999; 123: 290-295
        • Nakhleh R.E.
        • Gephardt G.
        • Zarbo R.J.
        Necessity of clinical information in surgical pathology: A College of American Pathologists Q-Probes study of 771,475 surgical pathology cases from 341 institutions.
        Arch Pathol Lab Med. 1999; 123: 615-619
        • Nakhleh R.E.
        • Jones B.A.
        Q-Probes 95-03: Handling of Mammographically Detected Breast Biopsy Tissue. Data Analysis and Critique. College of American Pathologists, Northfield, IL1995
        • Nakhleh R.E.
        • Jones B.
        • Zarbo R.J.
        Mammographically directed breast biopsies: A College of American Pathologists Q-Probes study of clinical physician expectations and of specimen handling and reporting characteristics in 434 institutions.
        Arch Pathol Lab Med. 1997; 121: 11-18
        • Nakhleh R.E.
        • Zarbo R.J.
        Amended reports in surgical pathology and implications for diagnostic error detection and avoidance. A College of American Pathologists Q-Probes study of 1,667,547 accessioned cases in 359 laboratories.
        Arch Pathol Lab Med. 1998; 122: 303-309
        • Nakhleh R.E.
        • Zarbo R.J.
        Q-Probes 94-06: Surgical Pathology Specimen Identification and Accessioning. Data Analysis and Critique. College of American Pathologists, Northfield, IL1995
        • Nakhleh R.E.
        • Zarbo R.J.
        Q-Probes 96-05: Amended Reports in Surgical Pathology. Data Analysis and Critique. College of American Pathologists, Northfield, IL1996
        • Nakhleh R.E.
        • Zarbo R.J.
        Surgical pathology specimen identification and accessioning. A College of American Pathologists Q-Probes study of 1,004,115 cases from 417 institutions.
        Arch Pathol Lab Med. 1996; 120: 227-233
        • Novis D.A.
        • Gephardt G.N.
        Small Hospital Q-Probe 94-11: Surgical Pathology Frozen Section Consultation. Data Analysis and Critique. College of American Pathologists, Northfield, IL1994
        • Novis D.A.
        • Gephardt G.
        • Zarbo R.J.
        Interinstitutional comparison of frozen section consultation in small hospitals: A College of American Pathologists Q-Probes study of 18,532 frozen section consultation diagnoses in 233 small hospitals.
        Arch Pathol Lab Med. 1996; 120: 1087-1093
        • Novis D.A.
        • Zarbo R.J.
        Interinstitutional comparison of frozen section turnaround time. A College of American Pathologists Q-Probes study of 32,868 frozen sections in 700 hospitals.
        Arch Pathol Lab Med. 1997; 121: 559-567
        • Novis D.A.
        • Zarbo R.J.
        Q-Probes 95-06: Frozen Section Turnaround Time. Data Analysis and Critique. College of American Pathologists, Northfield, IL1995
        • Novis D.A.
        • Zarbo R.J.
        • Valenstein P.A.
        Diagnostic uncertainty expressed in prostate needle biopsies: A College of American Pathologists Q-Probes study of 15,753 prostate needle biopsies in 332 institutions.
        Arch Pathol Lab Med. 1999; 123: 687-692
        • Owen D.A.
        • Tighe J.R.
        Quality evaluation in histopathology.
        BMJ. 1975; 1: 149-150
        • Penner D.W.
        Quality control and quality evaluation in histopathology and cytology.
        in: Sommers S.C. Pathol Ann. Appleton-Century-Crofts, New York1973: 1-19
        • Ramsay A.D.
        • Gallagher P.J.
        Local audit of surgical pathology: 18 months’ experience of peer review based quality assessment in an English teaching hospital.
        Am J Surg Pathol. 1992; 16: 476-482
        • Reporting on Cancer Specimens
        Protocols and Case Summaries. College of American Pathologists, Northfield, IL1998
        • Robboy S.J.
        • Bentley R.C.
        • Krigman H.
        • et al.
        Synoptic reports in gynecologic pathology.
        Int J Gynecol Pathol. 1994; 13: 161-174
        • Rosai J.
        Borderline epithelial lesions of the breast.
        Am J Surg Pathol. 1991; 15: 209-221
        • Rosai J.
        Standardized reporting of surgical pathology diagnosis for the major tumor types: A proposal.
        Am J Clin Pathol. 1993; 100: 240-255
        • Safrin R.E.
        • Bark C.J.
        Surgical pathology signout. Routine review of every case by a second pathologist.
        Am J Surg Pathol. 1993; 17: 1190-1192
        • Saladino A.J.
        • Zarbo R.J.
        Small Hospital Q-Probe 93-11: Surgical Pathology Diagnosis Turnaround Time. Data Analysis and Critique. College of American Pathologists, Northfield, IL1994
        • Schifman R.B.
        • Howanitz P.J.
        • Zarbo R.J.
        Q-Probes: A College of American Pathologists benchmarking program for quality management in pathology and laboratory medicine.
        in: Weinstein R.S. Advances in Pathology and Laboratory Medicine. Mosby-Yearbook, Chicago1996: 83-120
        • Schnitt S.S.
        • Connolly J.L.
        • Tavassoli F.A.
        Interobserver reproducibility in the diagnosis of ductal proliferative breast lesions using standardized criteria.
        Am J Surg Pathol. 1992; 16: 1133-1143
        • Scottolini A.G.
        • Weinstein S.R.
        The autopsy in clinical quality control.
        JAMA. 1983; 250: 1192-1194
        • Travers H.
        Quality Improvement Manual in Anatomic Pathology. College of American Pathologists, Northfield, IL1993
        • US Department of Health and Human Services
        Medicare, Medicaid and CLIA Programs: Clinical Laboratory Improvement Amendments of 1988 (CLIA ‘88) Final Rules. US Government Printing Office, Washington, DC1992
        • Whitehead M.E.
        • Fitzwater J.E.
        • Lindley S.K.
        • et al.
        Quality assurance of histopathologic diagnoses: A prospective audit of three thousand cases.
        Am J Clin Pathol. 1984; 81: 487-491
        • Zarbo R.J.
        Interinstitutional assessment of colorectal carcinoma surgical pathology report adequacy: A College of American Pathologists Q-Probes Study of practice patterns from 532 laboratories and 15,940 reports.
        Arch Pathol Lab Med. 1992; 116: 1113-1119
        • Zarbo R.J.
        Q-Probes 89-04A: Fine Needle Aspiration Cytohistologic Correlation: Data Analysis and Critique. College of American Pathologists, Northfield, IL1989
        • Zarbo R.J.
        • Baker P.B.
        • Howanitz P.J.
        The autopsy as a performance measurement tool-diagnostic discrepancies and unresolved clinical questions. A College of American Pathologists Q-Probes study of 2479 autopsies from 248 institutions.
        Arch Pathol Lab Med. 1999; 123: 191-198
        • Zarbo R.J.
        • Baker P.B.
        • Howanitz P.J.
        Quality assurance of autopsy permit form information, timeliness of performance and issuance of preliminary report: A College of American Pathologists Q-Probes study of 5434 autopsies from 452 institutions.
        Arch Pathol Lab Med. 1996; 120: 346-352
        • Zarbo R.J.
        • Fenoglio-Preiser C.M.
        Interinstitutional database for comparison of performance in lung fine-needle aspiration cytology. A College of American Pathologists Q-Probe study of 5264 cases with histologic correlation.
        Arch Pathol Lab Med. 1992; 116: 463-470
        • Zarbo R.J.
        • Fenoglio-Preiser C.M.
        Q-Probes 90-17A: Lung Cancer FNAC Diagnostic Performance. Data Analysis and Critique. College of American Pathologists, Northfield, IL1991
        • Zarbo R.J.
        • Fenoglio-Preiser C.M.
        Q-Probes 91-03A: Colorectal Carcinoma Surgical Pathology Report Adequacy. Data Analysis and Critique. College of American Pathologists, Northfield, IL1991
        • Zarbo R.J.
        • Gephardt G.N.
        Q-Probes 92-09: Surgical Pathology Routine Biopsy Turnaround Time. Data Analysis and Critique. College of American Pathologists, Northfield, IL1993
        • Zarbo R.J.
        • Gephardt G.N.
        Q-Probes 93-09: Surgical Pathology Complex Specimen Turnaround Time. Data Analysis and Critique. College of American Pathologists, Northfield, IL1994
        • Zarbo R.J.
        • Gephardt G.N.
        • Howanitz P.J.
        Intralaboratory timeliness of surgical pathology reports: Results of two College of American Pathologists Q-Probes studies of biopsies and complex specimens.
        Arch Pathol Lab Med. 1996; 120: 234-244
        • Zarbo R.J.
        • Hoffman G.G.
        • Howanitz P.J.
        Interinstitutional comparison of frozen section consultation: A College of American Pathologists Q-Probe study of 79,647 consultations in 297 North American institutions.
        Arch Pathol Lab Med. 1991; 115: 1187-1194
        • Zarbo R.J.
        • Howanitz P.J.
        • Bachner P.
        Interinstitutional comparison of performance in breast fine-needle aspiration cytology: A Q-Probe quality indicator study.
        Arch Pathol Lab Med. 1991; 115: 743-750
        • Zarbo R.J.
        • Kraemer B.B.
        Q-Probes 89-06A: Cervicovaginal Cytology Specimen Adequacy. Data Analysis and Critique. College of American Pathologists, Northfield, IL1990
        • Zarbo R.J.
        • Nakhleh R.E.
        Q-Probes 97-02: Specimens for Gross Exam Only or Exempt From Submission. Data Analysis and Critique. College of American Pathologists, Northfield, IL1997
        • Zarbo R.J.
        • Nakhleh R.E.
        Surgical pathology specimens for gross exam only and exempt from submission: a College of American Pathologists Q-Probes study of current policies in 413 institutions.
        Arch Pathol Lab Med. 1999; 123: 133-139
        • Zarbo R.J.
        • Schmidt W.A.
        • Bachner P.
        • et al.
        Indications and immediate patient outcomes of pathology intraoperative consultations: A College of American Pathologists/Centers for Disease Control and Prevention outcomes working group study.
        Arch Pathol Lab Med. 1996; 120: 12-25

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      DOI: https://doi.org/10.1016/S0272-2712(18)30086-6

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      © 1999 Elsevier Inc. Published by Elsevier Inc. All rights reserved.

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